Provider Demographics
NPI:1164841714
Name:LIFECARE INFUSION LLC
Entity Type:Organization
Organization Name:LIFECARE INFUSION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST-IN-CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:UCHE
Authorized Official - Middle Name:
Authorized Official - Last Name:EGBUCHUNAM
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD; RPH
Authorized Official - Phone:713-541-6000
Mailing Address - Street 1:PO BOX 571854
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77257-1854
Mailing Address - Country:US
Mailing Address - Phone:713-541-6000
Mailing Address - Fax:713-541-6001
Practice Address - Street 1:6300 RICHMOND AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77057-5931
Practice Address - Country:US
Practice Address - Phone:713-640-5353
Practice Address - Fax:713-640-5217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-10
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261873336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX26187OtherTEXAS BOARD OF PHARMACY